BackgroundHigh-risk open abdomen (OA) patients with acute gastrointestinal injury (AGI) and persistent enteral nutrition (EN) intolerance are particularly vulnerable to cumulative energy-protein deficit, yet the optimal timing of supplemental parenteral nutrition (SPN) remains uncertain. We evaluated whether earlier SPN initiation was associated with a lower subsequent incidence of enteroatmospheric fistula (EAF) in this population.MethodsWe conducted a single-center retrospective cohort study of adult OA patients admitted to the intensive care unit between January 2019 and December 2024 who had AGI grade II-III, persistent EN intolerance by ICU Day 3, and a modified Nutrition Risk in the Critically Ill score of at least 5. Using ICU Day 7 as the landmark time point, patients who initiated SPN between ICU Days 3 and 7 were classified as the early-SPN group, and those who initiated SPN after ICU Day 7 as the late-SPN group. Patients who never received SPN were intentionally excluded to focus the analysis on the optimal timing among those who definitively required supplementation. One-to-one propensity score matching was performed. The primary outcome was EAF occurring after ICU Day 7.ResultsAmong 355 screened patients, 284 met the eligibility criteria, including 110 early-SPN and 174 late-SPN patients; 102 matched pairs were analyzed. During ICU Days 3–7, the early-SPN group received higher energy and protein delivery. EAF occurred in 13/102 patients (12.75%) in the early-SPN group and 31/102 (30.39%) in the late-SPN group (relative risk, 0.42; 95% CI, 0.23–0.75; p = 0.002). In an exploratory landmark time-to-event analysis, early SPN was associated with a lower subsequent hazard of EAF (HR, 0.39; 95% CI, 0.21–0.75; log-rank p = 0.003). Mechanical ventilation duration was shorter in the early-SPN group (8.27 ± 10.53 vs. 12.00 ± 13.80 days, p = 0.031), whereas other secondary outcomes were comparable.ConclusionAmong high-risk OA patients with AGI and persistent EN intolerance who subsequently required SPN, initiation of SPN between ICU Days 3 and 7 was associated with improved short-term nutritional delivery, shorter mechanical ventilation duration, and a lower subsequent incidence of EAF than later SPN initiation.

Studies focusing on surgical recurrence of Crohn’s disease (CD) after ileocecal resection (ICR) are limited. This study aimed to identify the risk factors for long-term CD surgical recurrence following ICR. We retrospectively analyzed 504 patients who underwent ICR for CD between July 2016 and September 2020. The primary outcome was surgical recurrence, and anastomotic recurrence was also evaluated. Survival and associations between clinical factors and outcomes were investigated using Kaplan-Meier analyses and Cox proportional hazards models. We observed 76 surgical recurrences with a median follow-up of 75 (67–84 months). The surgical recurrence rate was significantly lower in patients who received prophylactic biologic therapy (P < 0.001). Preoperative anti-TNF exposure (HR, 1.659; 95

Background: Anorectal stricture is a challenging complication of Crohn’s disease (CD). Endoscopic needle-knife stricturotomy (NKSt) has emerged as a minimally invasive treatment option, but its long-term outcomes and factors influencing recurrence remain underexplored. Objectives: This study aimed to prospectively evaluate the long-term efficacy, safety, and risk factors for recurrence after NKSt for primary high-grade anorectal strictures in CD. Design: Single-center prospective cohort study. Methods: Between October 2020 and September 2023, 54 consecutive CD patients with primary high-grade anorectal strictures undergoing NKSt were enrolled. The primary endpoint was stricture recurrence requiring re-intervention. Risk factors were analyzed using univariable and multivariable Cox proportional hazards regression. Recurrence-free survival was estimated with the Kaplan-Meier method. A restricted cubic spline model within the Cox framework was employed to explore the nonlinear relationship between stricture length and recurrence. Results: The median follow-up was 24 months (interquartile range (IQR): 6–43). Immediate technical success was achieved in all patients (100%), and 38 patients (70.4%) reported symptomatic improvement at 3 months. Recurrence occurred in 20 patients (37.0%). Multivariable analysis identified stricture length (hazard ratio (HR) 1.184 per cm increase, 95% confidence interval (CI): 1.015–1.380; p = 0.032), the presence of an ostomy (HR 3.901, 95% CI: 1.406–10.823; p = 0.009), and concurrent biologic therapy (HR 0.177, 95% CI: 0.057–0.546; p = 0.003) as independent predictors of recurrence. In univariable analysis, NKSt combined with bleomycin injection was associated with a lower recurrence risk compared to NKSt alone ( p = 0.027). Conclusion: NKSt is an effective and safe treatment for primary high-grade anorectal strictures in CD, although recurrence is common. Stricture length, ostomy status, and the use of biologic agents are independent predictors of recurrence, while concomitant bleomycin injection may reduce recurrence risk. These findings can inform individualized treatment strategies and highlight the need for validation in larger, multicenter trials.

Gastrointestinal wall defects (e.g., perforations and leaks) present significant clinical challenges due to high rates of leakage, infection, and postoperative tissue adhesions. Current synthetic patches lack biocompatibility, leading to chronic inflammation, poor tissue integration, and postoperative tissue adhesion. To overcome these issues, this study introduces a multifunctional tissue-engineered gastrointestinal patch (TEGIP) that combines an extracellular matrix (ECM)-derived biomaterials with a wet-adhesive system and an anti-adhesion layer. The tri-layer TEGIP, designed for rapid modular assembly using off-the-shelf components, comprises an acellular dermal matrix (ADM) for mechanical support and tissue repair; a photo-crosslinkable methacrylated hyaluronic acid (HAMA) hydrogel layer to minimize peritoneal attachments; and a polyethyleneimine/polyacrylic acid (PEI/PAA) powder-based adhesive for rapid wet bonding. The structural integrity of tri-layer TEGIP is maintained through physical interlocking and interfacial interpenetration without the need for additional chemical crosslinking. In vitro evaluations confirmed robust mechanical durability (11.6 ± 2.0 MPa), effective reduction of cell adhesion by the HAMA layer, and PEI/PAA bonding strength comparable to fibrin glue, and high burst pressures (155 ± 22 mmHg) when sealing a 10-mm perforation. In a rat acute gastric perforation model, the TEGIP effectively sealed defects and significantly reduced postoperative adhesions. Moreover, TEGIP potentially facilitated tissue repair by guiding M2 macrophage polarization and mitigating excessive collagen deposition at repair stie. Additionally, no adverse hepato-renal toxicity was observed, ensuring sustained biocompatibility. These findings position the TEGIP as a promising sutureless solution for gastrointestinal defect sealing, offering robust sealing, enhanced biocompatibility, and reduced adhesion-related complications. STATEMENT OF SIGNIFICANCE: Tri-layered tissue-engineered gastrointestinal patch (TEGIP) was developed as a multifunctional sealant for gastrointestinal defect repair, comprising a middle layer of acellular dermal matrix for mechanical strength, an anti-adhesion layer of photo-crosslinkable methacrylated hyaluronic acid hydrogel to minimize postoperative adhesions, and an adhesive layer of polyethyleneimine/polyacrylic acid (PEI/PAA) hydrogel for robust wet adhesion. The PEI/PAA powder, applied directly to the TEGIP, forms a physical crosslink by absorbing tissue moisture, ensuring secure adhesion.

Objective To explore the current status and influencing factors of opportunistic infections in Crohn disease.Methods Data on demographic characteristics,disease features,treatment regimens and laboratory results of 369 patients with Crohn disease admitted to a tertiary grade A hospital in Shanghai from January 2020 to August 2024 were retrospectively collected.Univariate analysis and multivariate Logistic regression were employed to identify the influencing factors of opportunistic infections in Crohn disease.Results The incidence of opportunistic infections in patients with Crohn disease was 32.25％.Specifically,the incidence rates of viral infections,bacterial infections,and multiple infections were 16％,12.2％,and 3.8％,respectively.Multivariate Logistic regression analysis showed that low disease activity[odds ratio(OR)=3.22,95％CI:1.18-8.81,P=0.023],moderate disease activity(OR=7.16,95％CI:1.88-27.31,P=0.004),albumin<30 g/L(OR=4.99,95％CI:2.04-12.18,P<0.001),and C-reactive protein>10 mg/L(OR=3.70,95％CI:1.27-10.78,P=0.016)were independent risk factors for Crohn disease complicated with Epstein-Barr virus infection.A Charlson comorbidity index score of 1(OR=5.01,95％CI:1.51-16.60,P=0.008),albumin<30 g/L(OR=3.45,95％CI:1.23-9.72,P=0.019),and C-reactive protein>10 mg/L(OR=13.06,95％CI:2.46-69.40,P=0.003)were independent risk factors for Crohn disease complicated with latent mycobacterium tuberculosis infection.C-reactive protein>10 mg/L(OR=20.41,95％CI:2.13-195.52,P=0.009)was an independent risk factor for Crohn disease complicated with multiple infections.Conclusions Disease activity,co-existing chronic diseases,hypoalbuminemia,and elevated C-reactive protein levels are predictive factors for opportunistic infections in patients with Crohn disease.Active prevention as well as early diagnosis and treatment should be implemented for these patients at risk.

In order to better understand the trends and hot spots in angiogenesis research in metastatic colorectal cancer, this study uses bibliometric analysis to conduct a systematic analysis. Publications were retrieved from Web of Science Core Collection from 2000 to 2023. All studies were output for further analysis in R and CiteSpace software. A total of 5875 studies were recruited via the Web of Science Core Collection from 2000 to 2023 regarding the field of angiogenesis in metastatic colorectal cancer. China and USA were the leading country with top country publications. Among all contributed authors, the main three subjects were determined as cell biology, oncology, and peripheral vascular disease. Furthermore, network analysis of all recruited studies identified 16 research subjects. Next, the top 25 countries, authors references, institutions, and keywords with the strongest citation bursts were identified. To further delineate the growth and change of two types of keywords, Keywords Plus® and author keywords, a heatmap analysis was employed. Last, the most influential references relating to this field were identified using the strongest citation bursts. This study explored the research hot spots and trends of angiogenesis in metastatic colorectal cancer through bibliometric analysis. It would help researchers better understand the current status and future development hotspots of global research to promote further development in this field.

Objectives: To identify transfusion thresholds and risk factors for acute kidney injury (AKI) in gastrointestinal oncology surgery, enhancing early intervention and improving postoperative outcomes. Methods: From 2018 to 2022, 765 patients with gastric or colorectal cancer who underwent major gastrointestinal surgery were retrospectively enrolled. The primary outcome was AKI development within 7 days postoperatively. Clinicopathological characteristics and short-term outcomes were recorded and compared. Results: Of all enrolled patients, 39 (5.1%) developed AKI. Patients with AKI were predominantly older and had more preoperative comorbidities, lower levels of preoperative hemoglobin and serum albumin, but higher levels of blood urea nitrogen and serum creatinine (SCr). Patients developing AKI experienced higher rates of in-hospital complications (overall: 48.3% vs. 14.2%, p < 0.001), prolonged hospital stays (25.4 ± 22.5 days vs. 12.3 ± 7.9 days, p < 0.001), increased intensive care unit (ICU) admissions (53.8% vs. 22.5%, p < 0.001), and higher rates of 30-day re-admission (13.9% vs. 2.4%, p = 0.003). Significant AKI risk factors included age (per 10 years, OR: 1.567, 95% CI: 1.103-2.423, p = 0.043), preoperative SCr (per 10 μmol/L, OR: 1.173, 95% CI: 1.044-1.319, p = 0.007), intraoperative RBC transfusion (per 1000 mL, OR: 1.992, 95% CI: 1.311-3.027, p = 0.001 with a significant surge in AKI risk at transfusions exceeding 1500 mL), patient-controlled analgesia (protective, OR:0.338, 95% CI: 0.163-0.928, p = 0.033), and diuretic use (OR: 5.495, 95% CI: 1.720-17.557, p = 0.004). Conclusions: Early intervention is essential for patients with preoperative low perfusion or anemia, with particular emphasis on moderating interventions to avoid fluid overload while carefully avoiding nephrotoxic medications, thereby improving postoperative outcomes.

Background:Massive postoperative gastrointestinal bleeding is a severe postoperative complication of Crohn's disease (CD) with a high mortality rate, and deteriorating patients' recovery. However, there are few related studies, and it lacks effective prevention measures. Therefore, we conducted a multicenter study to explore the risk factors for massive postoperative gastrointestinal bleeding in CD patients. Methods:This study was a multicenter retrospective case-control study. Patients who were diagnosed with CD and underwent gastrointestinal (GI) surgery were enrolled. The control group was matched 1:4 for gender and age. By comparing perioperative medical information between two groups, risk factors were identified through logistic regression analysis. A nomogram was constructed and internal validation was performed by bootstrap resampling. Results:A total of 170 patients were included. Multivariable logistic regression revealed the independent predictors of massive postoperative gastrointestinal bleeding involving the number of previous abdominal surgeries (OR = 2.56, 95% CI = 1.54-4.24), GI bleeding history (OR = 6.17, 95% CI = 1.59-23.97), serum albumin (ALB) (OR = 0.88, 95% CI = 0.81-0.96), and Nutrition Risk Screening 2002 (OR = 1.57, 95% CI = 1.08-2.29). The nomogram achieved an area under the curve (AUC) value of 0.85 (95% CI: 0.76-0.93). In internal validation, the AUC value was 0.976 (95% CI: 0.955-0.997). Calibration curves showed good alignment. DCA demonstrated that the diagnostic model had good clinical efficiency. Conclusion:The risk of massive postoperative gastrointestinal bleeding in CD patients will be increased with a GI bleeding history, more previous abdominal surgeries, higher nutrition risk, and lower ALB level. Our nomogram model is effective and could be a useful tool for prediction.

Crohn’s disease (CD) is a chronic inflammatory disease that is prone to complications such as intestinal obstruction and perforation, which often require surgical treatments. Massive postoperative gastrointestinal bleeding (MPGB) is a severe complication with a high mortality rate, deteriorating postoperative recovery and disease prognosis. However, there are few related studies and it lacks effective prevention measures. Therefore, we conducted a multicenter study to explore the risk factors for MPGB in CD patients. This study was a multicenter retrospective case-control study. Inclusion criteria included: patients diagnosed with CD; aged over 16 years old; underwent gastrointestinal surgery. Exclusion criteria included: patients with massive gastrointestinal bleeding before surgery. Massive gastrointestinal bleeding is defined as: hemodynamic impairment, requiring active fluid resuscitation; and decreased hemoglobin concentration, requiring blood transfusion or surgical treatment; with symptoms of gastrointestinal bleeding. The included patients were divided into a case group and a control group. By comparing medical information between two groups, risk factors for MPGB were identified through logistic regression analysis, and a nomogram was constructed. From January 2018 to February 2024, a total of 170 CD patients were included in the study, including 34 patients with MPGB and 136 matched controls. Univariate logistic regression analysis showed that for albumin (P=0.001, OR=0.89), nutrition risk screening (NRS2002) scale (P=0.003, OR=1.61), predictive nutritional index (PNI) (P=0.005, OR=0.92), number of previous surgeries (P< 0.001, OR=2.39), history of gastrointestinal bleeding (P< 0.001, OR=8.75), international normalized ratio (INR) (P=0.004, OR=1.60), and abnormal liver function (P=0.049, OR=6.29) (P<0.05), the difference between two groups was statistically significant. Multivariate logistic regression analysis further revealed that NRS2002 (P=0.022, OR=1.53), history of gastrointestinal bleeding (P=0.005, OR=5.71), number of previous surgeries (P< 0.001, OR=2.43), and INR (P=0.011, OR=1.61) were associated with an increased risk of MPGB. Based on these results, a nomogram was constructed. The training and validation group achieved an area under the curve (AUC) value of 0.87 and 0.73 respectively with well-fitted Hosmer-Lemeshow calibration curves (P >0.05). The risk of MPGB in CD patients will be increased with a history of gastrointestinal bleeding, more previous surgeries, a higher NRS2002 score, and a higher INR value. Strengthening the perioperative nutritional status management of CD patients may prevent the MPGB. Besides, we conduct a nomogram model, which can effectively predict the risk of MPGB in CD patients. Table 1 Figure 1

Background and Aims Myenteric plexitis is correlated with postoperative recurrence of Crohn's disease when relying on traditional statistical methods. However, comprehensive assessment of myenteric plexus remains challenging. This study aimed to develop and validate a deep learning system to predict postoperative recurrence through automatic screening and identification of features of the muscular layer and myenteric plexus.Methods We retrospectively reviewed 205 patients who underwent bowel resection surgery from two hospitals. Patients were divided into a training cohort [n = 108], an internal validation cohort [n = 47], and an external validation cohort [n = 50]. A total of 190 960 patches from 278 whole-slide images of surgical specimens were analysed using the ResNet50 encoder, and 6144 features were extracted after transfer learning. We used five robust algorithms to construct classification models. The performances of the models were evaluated based on the area under the receiver operating characteristic curve [AUC] in three cohorts.Results The stacking model achieved satisfactory accuracy in predicting postoperative recurrence of CD in the training cohort (AUC: 0.980; 95% confidence interval [CI] 0.960-0.999), internal validation cohort [AUC: 0.908; 95% CI 0.823-0.992], and external validation cohort [AUC: 0.868; 95% CI 0.761-0.975]. The accuracy for identifying the severity of myenteric plexitis was 0.833, 0.745, and 0.694 in the training, internal validation and external validation cohorts, respectively.Conclusions Our work initially established an interpretable stacking model based on features of the muscular layer and myenteric plexus extracted from histological images to identify the severity of myenteric plexitis and predict postoperative recurrence of CD. Graphical Abstract

Background:Crohn's disease continues to be a major component of inflammatory bowel disease with increasing incidence and prevalence. Increasing publications of surgery in Crohn's disease have significantly expanded the research scope. The aim of this study is to characterize main topics and a full landscape of surgery in Crohn's disease. Methods:Studies of surgery in Crohn's disease from 2000 to 2020 were screened and retrieved from the Web of Science Core Collection database. Latent Dirichlet allocation (LDA), one of machine-learning algorithms for natural language processing, was employed for topic modeling. All the studies were processed, analyzed and visualized by R software, CiteSpace and Gephi. Results:A total of 3,697 original publications were identified from the database. USA was the leading country with the most top institutions such as Cleveland Clin Florida and Mayo Clinic and Mayo Foundation. Increasing impact of institutions from Korea and China was also noticed. Bo Shen was the leading author in publication. A machine learning based topic modeling identified major clusters, including disease assessment, surgical treatment and complications, risk factors and epidemiology, disease development and diagnosis, target treatment and recurrence. Three topics attracted continuous high research attention, including expression of intestinal cell, perianal fistula and laparoscopic and open operation. Conclusions:This study identified key topics relating to the development of surgery in Crohn's disease, and provided bibliometric insights and perspectives for future development in the field of surgery in Crohn's disease.

This retrospective observational study aimed to evaluate the incidence of surgical site infection (SSI) in the era of enhanced recovery after surgery (ERAS) and the effect of ERAS on postoperative outcomes. Totally 1,276 patients (565 in ERAS group and 711 in non-ERAS group) who underwent operations at the department of general surgery during 2017-2021 were included. Risk factors were identified via logistic regression analysis and meta-analysis of all relevant published studies was performed. Subsequently, propensity score matching was used to match different risk factors. Overall, 40 patients were diagnosed with SSI, and the pooled incidence of SSI was 3.13%. In total, 14 (2.48%) and 26 (3.66%) patients in the ERAS and non-ERAS groups, respectively, were diagnosed with SSI (P = 0.230). Among patients for whom the ERAS protocol was adopted, 7 independent risk factors of SSI were identified. After propensity score matching, in patients without SSI, the number of hospital days was significantly lower in the ERAS group than in the non-ERAS group (2 [2, 5] vs. 3 [2, 7], P = 0.005), whereas in patients with SSI, the number of hospital days was similar between the ERAS and non-ERAS groups. ERAS had no effect on the incidence of SSI but could significantly accelerate the discharge of uninfected patients. In the era of ERAS, SSI incidence was affected by the type of surgery; number of postoperative hospital days; type of incision; serum hemoglobin, total protein, and albumin levels; and antibiotic prophylaxis. Furthermore, these results will significantly affect the implementation of the ERAS protocol and optimal preoperative management.

BackgroundAnti-TNF therapy has been found to exert an influence on long-term nutritional status and even reverse malnutrition in patients with Crohn’s disease.Aimsto observe the effect of anti-TNF therapy on nutritional status in patients with Crohn’s disease, investigate the correlation between the timing of anti-TNF therapy and the human body composition and examine independent body composition factors for predicting malnutrition in these patients.MethodsThis was a retrospective study of 115 patients with Crohn’s disease. Body composition parameters were assessed by bioelectrical impedance analysis. The nutritional status of the patients was determined by NRS2002 and MNA.ResultsThe BMI, BFMI, FFMI, BCMI, SMI, BMC, intracellular water, protein and BMR were significantly lower in patients without any biologic agents (p < 0.05). Negative correlations were found between BMC, intracellular water, extracellular water, protein and BMR and the interval between the first symptom and first dose by Spearman’s correlation analysis (r < 0, p < 0.05). Low BMI (OR 0.602, 95% CI 0.434–0.836, p = 0.002), low FFMI (OR 0.678, 95% CI 0.507–0.906, p = 0.009), and low BCMI (OR 0.564, 95% CI 0.367–0.868, p = 0.009) were independent risk factors for malnutrition in Crohn’s disease patients. Anti-TNF therapy tended to reduce the malnutrition probability as assessed by Cox regression analysis (OR: 0.217, 95% CI 0.057–0.821, p = 0.024).ConclusionBody composition analysis is predictive of malnutrition in patients with Crohn’s disease. Early application of anti-TNF therapy significantly affected skeletal muscle mass, fat mass and bone mineral content, supporting their long-term nutritional status and reducing their probability of malnutrition.

Extracellular vesicles (EVs) are a class of spherical vesicles that are produced by active secretion of cells and encapsulated by phospholipid bilayers. In recent years, numerous studies have shown that EVs play pivotal roles in the regulation of intercellular communication between colorectal cancer (CRC) cells and target cells, and can regulate the proliferation, metastasis, and infiltration of tumor cells by regulating the microenvironment of tumor cells. EVs carry specific molecular substances in source CRC cells and are expected to serve as new molecular markers for the detection of cancers. This review highlights the current state of research and progress of potentially incorporating EVs in the diagnosis and treatment of CRC.

Introduction:Short bowel syndrome (SBS) is featured by impaired nutrients and fluids absorption due to massive small intestine resection. Gut dysbiosis has been implicated in SBS, this study aimed to characterize the metagenomic and metabolomic profiles of SBS and identify potential therapeutic targets.Methods:Fecal samples from SBS and Sham rats (n = 8 per group) were collected for high-throughput metagenomic sequencing. Fecal metabolomics was measured by untargeted liquid chromatography-mass spectrometry.Results:We found that the species-level α-diversity significantly decreased in SBS rats, accompanied by altered microbiome compositions. The beneficial anaerobes from Firmicutes and Bacteroidetes were depleted while microorganisms from Lactobacillus, Escherichia, Enterococcus, and Streptococcus were enriched in faces from SBS rats. LEfSe analysis identified 17 microbial species and 38 KEGG modules that were remarkably distinct between SBS and Sham rats. In total, 1,577 metabolites with known chemical identity were detected from all samples, among them, 276 metabolites were down-regulated and 224 metabolites were up-regulated in SBS group. The typical signatures of SBS fecal metabolome comprised reduced short-chain fatty acids and products of amino acid metabolism (indole derivatives and p-cresol), as well as altered bile acid spectrum. We revealed 215 robust associations between representative differentially abundant microbial species and metabolites, the species with the same changing trend tended to have a similar correlation with some certain metabolites.Conclusion:The fecal microbiome and metabolome significantly altered in SBS. Our findings may lay the foundation for developing new strategies to facilitate intestinal adaptation in SBS patients.

Background The rapid growth of publications on the gut microbiome and colorectal cancer (CRC) makes it feasible for text mining and bibliometric analysis. Methods Publications were retrieved from the Web of Science. Bioinformatics analysis was performed, and a machine learning-based Latent Dirichlet Allocation (LDA) model was used to identify the subfield research topics. Results A total of 5,696 publications related to the gut microbiome and CRC were retrieved from the Web of Science Core Collection from 2000 to 2022. China and the USA were the most productive countries. The top 25 references, institutions, and authors with the strongest citation bursts were identified. Abstracts from all 5,696 publications were extracted for a text mining analysis that identified the top 50 topics in this field with increasing interest. The colitis animal model, expression of cytokines, microbiome sequencing and 16s, microbiome composition and dysbiosis, and cell growth inhibition were increasingly noticed during the last two years. The 50 most intensively investigated topics were identified and further categorized into four clusters, including “microbiome sequencing and tumor,” “microbiome compositions, interactions, and treatment,” “microbiome molecular features and mechanisms,” and “microbiome and metabolism.” Conclusion This bibliometric analysis explores the historical research tendencies in the gut microbiome and CRC and identifies specific topics of increasing interest. The developmental trajectory, along with the noticeable research topics characterized by this analysis, will contribute to the future direction of research in CRC and its clinical translation.

Introduction Central lymph node metastasis (CLNM) is common in papillary thyroid carcinoma (PTC). Prophylactic central lymph node dissection (PCLND) in clinically negative central compartment lymph node (cN0) PTC patients is still controversial. How to predict CLNM before the operation is very important for surgical decision making. Methods In this article, we retrospectively enrolled 243 cN0 PTC patients and gathered data including clinical characteristics, ultrasound (US) characteristics, pathological results of fine-needle aspiration (FNA), thyroid function, eight gene mutations, and immunoenzymatic results. Least absolute shrinkage and selection operator (LASSO) analysis was used for data dimensionality reduction and feature analysis. Results According to the results, the important predictors of CLNM were identified. Multivariable logistic regression analysis was used to establish a new nomogram prediction model. The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) curve were used to evaluate the performance of the new prediction model. Discussion The new nomogram prediction model was a reasonable and reliable model for predicting CLNM in cN0 PTC patients, but further validation is warranted.

Sepsis-associated acute liver injury (SALI) is an independent risk for sepsis-induced death orchestrated by innate and adaptive immune responses. Here, we found that Roquin-1 was decreased during SALI and expressed mainly in monocyte-derived macrophages. Meanwhile, Roquin-1 was correlated with the inflammatory profiles in humans and mice. Mechanically, Roquin-1 in macrophages promoted Ago2-K258-ubiquitination and inhibited Ago2-S387/S828-phosphorylation. Ago2-S387-phosphorylation inhibited Ago2-miRNA's complex location in multivesicular bodies and sorting in macrophages-derived extracellular vesicles (MDEVs), while Ago2-S828-phosphorylation modulated the binding between Ago2 and miRNAs by special miRNAs-motifs. Then, the anti-inflammatory miRNAs in MDEVs decreased TSC22D2 expression directly, upregulated Tregs-differentiation via TSC22D2-STAT3 signaling, and inhibited M1-macrophage-polarization by TSC22D2-AMPKα-mTOR pathway. Furthermore, WT MDEVs in mice alleviated SALI by increasing Tregs ratio and decreasing M1-macrophage frequency synchronously. Our study showed that Roquin-1 in macrophages increased Tregs-differentiation and decreased M1-macrophage-polarization simultaneously via miRNA in MDEVs, suggesting Roquin-1 can be used as a potential tool for SALI treatment and MDEVs engineering.

目的 检索、评价并总结经膀胱腹内压测量的最佳证据.方法 按照循证资源"6S"模型自上而下的原则,系统检索国内外文献数据库及网站中关于经膀胱腹内压测量的所有证据,包括指南、证据总结、临床决策、系统评价、专家共识及原始研究等,检索时限为建库至2022年12月31日.由2名具备系统循证培训经历的研究者独立对文献资料进行质量评价和内容提取,并结合专业判断,进行证据汇总.结果 共纳入17篇文献,其中指南4篇、专家共识2篇,系统评价1篇、推荐实践2篇、证据总结4篇、横断面研究1篇、诊断性试验3篇.总结的最佳证据包括测量途径、测量时机、测量方法、测量工具、影响因素、人员培训6个方面的21条推荐意见.结论 该研究对经膀胱腹内压测量的最佳证据进行总结,为医护人员提供循证依据,建议临床应用时可根据临床具体情景,以科学提高临床腹内压测量的准确性和规范性.